scholarly journals Understanding what works, why and in what circumstances in hospice at home services for end-of-life care: Applying a realist logic of analysis to a systematically searched literature review

2019 ◽  
Vol 34 (1) ◽  
pp. 16-31 ◽  
Author(s):  
Ferhana Hashem ◽  
Charlotte Brigden ◽  
Patricia Wilson ◽  
Claire Butler
Keyword(s):  
Literature Review ◽  
Normalisation Process Theory ◽  
Care Providers ◽  
Programme Theory ◽  
Diverse Range ◽  
Business Elite ◽  
Funding Model ◽  
What Works ◽  
Hospice At Home ◽  
At Home

Background: We have undertaken a systematically searched literature review using a realist logic of analysis to help synthesise the diverse range of literature available on hospice at home services. Aim: To find out in the existing literature what features of hospice at home models work best, for whom and under what circumstances. Design: A realist logic of analysis was applied to synthesise the evidence focusing on mechanisms by which an intervention worked (or did not work). An initial programme theory was developed using the National Association for Hospice at Home standards, Normalisation Process Theory and through refinement using stakeholder engagement. Data sources: PubMed, Science Direct, AMED, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, Medline, PsychINFO, SCOPUS, Web of Science, DARE, Google Scholar, NHS Evidence, NIHR CRN portfolio database, NIHR journal library of funded studies, including searches on websites of relevant professional bodies (August 2014, June 2017, June 2019). Results: Forty-nine papers were reviewed, of which 34 contributed evidence to at least one of the eight theory areas: marketing and referral, sustainable funding model, service responsiveness and availability, criteria for service admission, knowledge and skills of care providers, integration and coordination, anticipatory care, support directed at carers. Conclusions: Our literature review showed how it was possible to develop a coherent framework and test it against 34 published papers and abstracts. Central to this review was theory building, and as further evidence emerges, our programme theories can be refined and tested against any new empirical evidence.

Evaluating a pilot paediatric hospice-at-home service: a literature review

2016 ◽  
Vol 22 (2) ◽  
pp. 90-97 ◽  
Author(s):  
Rowan Hillis ◽  
Julie Ling ◽  
Claire Quinn ◽  
Maria Brenner
Keyword(s):  
Literature Review ◽  
Home Service ◽  
Hospice At Home ◽  
At Home

A study protocol: co-designing a mobile application to enhance communication, safety and wellbeing for people living at home with early stage dementia (Preprint)

2020 ◽  
Author(s):  
Karen Davies ◽  
Bie Nio Ong ◽  
Sudeh Cheraghi-Sohi ◽  
Katherine Perryman ◽  
Caroline Sanders
Keyword(s):  
Mobile Application ◽  
Design Research ◽  
Early Stage ◽  
Design Method ◽  
Mobile Apps ◽  
Care Service ◽  
Normalisation Process Theory ◽  
Policy And Practice ◽  
People With Dementia ◽  
At Home

BACKGROUND Background: There is a growing interest in using mobile applications in supporting health and wellbeing. Evidence directly from people with dementia regarding the acceptability, usability and usefulness of mobile apps is limited. It builds on ‘My Health Guide’ which was co-designed with people with cognitive disabilities. . OBJECTIVE Objective This paper describes the protocol of a study evaluating an app designed for supporting wellbeing with people living with dementia, specifically focusing on enhanced safety through improved communication METHODS Method: The study will employ design research, using participatory qualitative research methods over three cycles of evaluation with service users, their families and practitioners. The study will be developed in partnership with a specialist home care service in England. A purposive case selection will be used to ensure that the cases exemplify differences in experiences. The app will be evaluated in a ‘walkthrough’ workshop by people living with early stage dementia and then trialled at home by up to 12 families in a ‘try-out’ cycle. An amended version will be evaluated in a final ‘walkthrough’ workshop in cycle 3. Data will be collected from at least four data sources during the try-out phase and analysed thematically (people with dementia, carers, practitioners and app usage). An explanatory, multiple-case study design will be used to synthesise and present the evidence from the three cycles drawing on Normalisation Process Theory to support interpretation of the findings. RESULTS Results: The study is ready to be implemented but has been paused to protect vulnerable individuals during the Coronavirus in 2020. The findings will be particularly relevant for understanding how to support vulnerable people living in the community during social distancing and the period following the pandemic, as well as providing insight into the challenges of social isolation arising from living with dementia CONCLUSIONS Discussion: Evaluating a mobile application for enhancing communication, safety and wellbeing for people living with dementia contributes to key ambitions enshrined in policy and practice, championing the use of digital technology and supporting people with dementia to live safely in their own homes. The study uses a co-design method to enable the voice of users with dementia to highlight the benefits and challenges of technology and shape future development of apps that potentially enhances safety through improved communication.

Perceived Effectiveness of Artificial Intelligence based Decision Support System in a Clinical Setting: A Systematic Literature Review (Preprint)

2020 ◽  
Author(s):  
Avishek Choudhury
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Decision Support ◽  
Literature Review ◽  
Decision Support System ◽  
Support System ◽  
Clinical Setting ◽  
Clinical Decision Making ◽  
Theoretical Perspective ◽  
Care Providers

UNSTRUCTURED Objective: The potential benefits of artificial intelligence based decision support system (AI-DSS) from a theoretical perspective are well documented and perceived by researchers but there is a lack of evidence showing its influence on routine clinical practice and how its perceived by care providers. Since the effectiveness of AI systems depends on data quality, implementation, and interpretation. The purpose of this literature review is to analyze the effectiveness of AI-DSS in clinical setting and understand its influence on clinician’s decision making outcome. Materials and Methods: This review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta- Analyses reporting guidelines. Literature will be identified using a multi-database search strategy developed in consultation with a librarian. The proposed screening process consists of a title and abstract scan, followed by a full-text review by two reviewers to determine the eligibility of articles. Studies outlining application of AI based decision support system in a clinical setting and its impact on clinician’s decision making, will be included. A tabular synthesis of the general study details will be provided, as well as a narrative synthesis of the extracted data, organised into themes. Studies solely reporting AI accuracy an but not implemented in a clinical setting to measure its influence on clinical decision making were excluded from further review. Results: We identified 8 eligible studies that implemented AI-DSS in a clinical setting to facilitate decisions concerning prostate cancer, post traumatic stress disorder, cardiac ailment, back pain, and others. Five (62.50%) out of 8 studies reported positive outcome of AI-DSS. Conclusion: The systematic review indicated that AI-enabled decision support systems, when implemented in a clinical setting and used by clinicians might not ensure enhanced decision making. However, there are very limited studies to confirm the claim that AI based decision support system can uplift clinicians decision making abilities.

scholarly journals Upskilling health and care workers with augmented and virtual reality: protocol for a realist review to develop an evidence-informed programme theory

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e050033
Author(s):  
Norina Gasteiger ◽  
Sabine N van der Veer ◽  
Paul Wilson ◽  
Dawn Dowding
Keyword(s):  
Virtual Reality ◽  
Grey Literature ◽  
Healthcare Providers ◽  
Realist Review ◽  
Relevant Information ◽  
Care Providers ◽  
Programme Theory ◽  
Clinical Educators ◽  
Continued Learning ◽  
Search Quality

IntroductionAugmented reality (AR) and virtual reality (VR) are increasingly used to upskill health and care providers, including in surgical, nursing and acute care settings. Many studies have used AR/VR to deliver training, providing mixed evidence on their effectiveness and limited evidence regarding contextual factors that influence effectiveness and implementation. This review will develop, test and refine an evidence-informed programme theory on what facilitates or constrains the implementation of AR or VR programmes in health and care settings and understand how, for whom and to what extent they ‘work’.Methods and analysisThis realist review adheres to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) standards and will be conducted in three steps: theory elicitation, theory testing and theory refinement. First, a search will identify practitioner, academic and learning and technology adoption theories from databases (MEDLINE, Scopus, CINAHL, Embase, Education Resources Information Center, PsycINFO and Web of Science), practitioner journals, snowballing and grey literature. Information regarding contexts, mechanisms and outcomes will be extracted. A narrative synthesis will determine overlapping configurations and form an initial theory. Second, the theory will be tested using empirical evidence located from the above databases and identified from the first search. Quality will be assessed using the Mixed Methods Appraisal Tool (MMAT), and relevant information will be extracted into a coding sheet. Third, the extracted information will be compared with the initial programme theory, with differences helping to make refinements. Findings will be presented as a narrative summary, and the MMAT will determine our confidence in each configuration.Ethics and disseminationEthics approval is not required. This review will develop an evidence-informed programme theory. The results will inform and support AR/VR interventions from clinical educators, healthcare providers and software developers. Upskilling through AR/VR learning interventions may improve quality of care and promote evidence-based practice and continued learning. Findings will be disseminated through conference presentations and peer-reviewed journal articles.

scholarly journals What does effective end-of-life care at home for children look like? A qualitative interview study exploring the perspectives of bereaved parents

2021 ◽  
pp. 026921632110233
Author(s):  
Cari Malcolm ◽  
Katherine Knighting
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Care Service ◽  
Life Care ◽  
Care Providers ◽  
Specialist Care ◽  
Bereaved Parents ◽  
Home Based ◽  
Qualitative Interview Study ◽  
At Home

Background: End-of-life care for children with life-shortening conditions is provided in a range of settings including hospital, hospice and home. What home-based, end-of-life care should entail or what best practice might look like is not widely reported, particularly from the perspective of parents who experienced the death of a child at home. Aim: To explore the value and assess the effectiveness of an innovative model of care providing home-based, end-of-life care as perceived by families who accessed the service. Design: A qualitative descriptive study design was employed with in-depth semi-structured interviews conducted with bereaved parents. Setting/participants: Thirteen bereaved parents of 10 children supported by the home-based end-of-life care service. Results: Parents reported effective aspects of end-of-life care provided at home to include: (1) ability to facilitate changes in preferred place of death; (2) trusted relationships with care providers who really know the child and family; (3) provision of child and family-centred care; (4) specialist care and support provided by the service as and when needed; and (5) quality and compassionate death and bereavement care. Parents proposed recommendations for future home-based end-of-life care including shared learning, improving access to home-based care for other families and dispelling hospice myths. Conclusion: Parents with experience of caring for a dying child at home offer valuable input to future the policy and practice surrounding effective home-based, end-of-life care for children. New models of care or service developments should consider the key components and attributes for effective home-based end-of-life identified by bereaved parents in this study.

scholarly journals Family and healthcare professionals’ perceptions of a pilot hospice at home programme for children: a qualitative study

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Maria Brenner ◽  
Michael Connolly ◽  
Des Cawley ◽  
Frances Howlin ◽  
Jay Berry ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Healthcare Professionals ◽  
Hospice At Home ◽  
At Home

TELE-MONITORING SYSTEM OF RISK IN RESPIRATORY PATIENTS

2021 ◽  
pp. 2150041
Author(s):  
Awad Al-Zaben ◽  
Lina M.K. Al-Ebbini ◽  
Badr Qatashah
Keyword(s):  
Health Care ◽  
Signal Processing ◽  
Health Care Providers ◽  
Mobile Phones ◽  
Model Parameters ◽  
Care Providers ◽  
Server Side ◽  
Respiration Signal ◽  
At Home

In many situations, health care professionals need to evaluate the respiration rate (RR) for home patients. Moreover, when cases are more than health care providers’ capacity, it is important to follow up cases at home. In this paper, we present a complete system that enables healthcare providers to follow up with patients with respiratory-related diseases at home. The aim is to evaluate the use of a mobile phone’s accelerometer to capture respiration waveform from different patients using mobile phones. Whereas measurements are performed by patients themselves from home, and not by professional health care personnel, the signals captured by mobile phones are subjected to many unknowns. Therefore, the validity of the signals has to be evaluated first and before any processing. Proper signal processing algorithms can be used to prepare the captured waveform for RR computations. A validity check is considered at different stages using statistical measures and pathophysiological limitations. In this paper, a mobile application is developed to capture the accelerometer signals and send the data to a server at the health care facility. The server has a database of each patient’s signals considering patient privacy and security of information. All the validations and signal processing are performed on the server side. The patient’s condition can be followed up over a few days and an alarm system may be implemented at the server-side in case of respiration deterioration or when there is a risk of a patient’s need for hospitalization. The risk is determined based on respiration signal features extracted from the received respiration signal including RR, and Autoregressive (AR) moving average (ARMA) model parameters of the signal. Results showed that the presented method can be used at a larger scale enabling health care providers to monitor a large number of patients.

scholarly journals Needs of patient with advanced stages of cancer in a Thai community

2018 ◽  
Vol 32 (5) ◽  
pp. 342-351
Author(s):  
Panita Krongyuth ◽  
Pimpan Silpasuwan ◽  
Chukiat Viwatwongkasem ◽  
Cathy Campbell
Keyword(s):  
Palliative Care ◽  
Content Analysis ◽  
Pain Management ◽  
Care Providers ◽  
Care Needs ◽  
Open Communication ◽  
Content Type ◽  
Advanced Stages ◽  
Palliative Care Needs ◽  
At Home

Purpose The purpose of this paper is to explore the needs of people with cancer in advanced stages and to analyze factors that influence them. Design/methodology/approach A concurrent mixed-method design was used. Descriptive design was conducted in Ubon Ratchathani Province, Thailand. Data were collected from a convenience sample of patients with advanced cancer of any tissue or organ. Questionnaires were completed by 110 patients aged 60 years and above (response rate 110/130=84.6 percent). In-depth interviews were conducted with a total of eight patients. Content analysis of semi-structured interviews of a sub-sample was subsequently performed to better understand the real needs of patients with advanced stages of cancer at home setting. Findings The majority (77.5 percent) reported a preference to spend their final days at home. The four most common palliative care needs were more information about disease and medical treatment (98.2 percent), more treatment for pain (97.3 percent), health education for family caregivers (95.5 percent) and health volunteers visit at home (95.5 percent). Content analysis of the qualitative data suggested that patient needs health care providers to deliver open communication, pain management and provide psychosocial supports. Originality/value The result showed that patients-related variables are associated with the palliative care needs in patients with advanced stages of cancer. Communication skills and pain management are the key components to support the need for palliative care at home and to benefit the quality of life in terminally ill patients.

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